The need to improve diversity in medicine is a well-recognized issue, especially in specialties like surgery. Many recruitment efforts are targeted at college students, but should they be starting even sooner than that?
Arden Morris, MD, MPH, vice chair of research in the Department of Surgery at Stanford Medical School, and her colleagues created a hands-on surgical pipeline for low-income high school students. The group of mostly Latino and African American teenagers demonstrated various significant positive changes after the program, including greater self-efficacy and a better understanding of the path to a healthcare career.
We spoke with Morris about how the program functioned, some surprising responses from students, and what the future holds for pipeline programs like these.
Can you describe the program you developed?
We wanted to reach teens from low-income high schools who were interested in a STEM [science, technology, engineering, and mathematics] field but who may have only had interactions with people in healthcare as patients or when their loved ones were patients. We were also looking for kids who were motivated but maybe hadn’t even tried on the idea of someday going to medical school or of doing something else in the health field.
Physician volunteers encourage STEM-interested teens to try on white coats.
We did a survey of the landscape, and one program was a particularly good fit for us: SMASH Academy. They host a 5-week residential program on the Stanford campus each summer specifically oriented to STEM. We asked them, “How about if we create another module that has to do with medicine and healthcare?” We called it, “SMASH Med.”
What did SMASH Med involve?
During the 5-week program, we had a weekly half-day or full-day session and a couple of weekend sessions. We created five modules designed to go through personal stories, thinking like a physician, and hands-on experiential learning. For the first session, the students interacted with a panel of speakers and listened to their stories. We selected healthcare providers and physicians who were from backgrounds similar to these kids.’
We invited a lot of Q&A. The kids asked all kinds of questions. They asked questions like, “Did you ever faint when you first saw blood? How much money do you make?” That one was a little surprising to some of our panelists! But they loved it because these teens were right up front. Some of the questions were really thoughtful around how to communicate sensitive information and dealing with stress.
STEM-interested teens interact with physicians during a health professionals panel.
The second workshop was about knot tying and basic laparoscopic surgery skills. This was almost like playing video games. Surgery is an action-based field, and we felt like we could reach these kids better if we had them doing activities, specifically hands-on activities.
In the third workshop, we taught students why and how to do a basic clinical exam by taking vital signs that would show them how to take blood pressure, pulse, and respiratory rate. They practiced on each other. Many shared that parents or grandparents had treatable conditions related to blood pressure, for example. Then we worked through different case presentations.
In the fourth session, we took them to an anatomy lab and showed them a virtual life-size cadaver. It was a high school–level discussion of what happens with organs inside the body. We tried to be alert to whether it was going to make the kids anxious or be a little too much for them, but they were totally engaged.
Our fifth workshop focused on empathy. We had several patient volunteers come in and tell their firsthand stories. Like a heart transplant, which is kind of amazing, right? And somebody who had been nonhearing became a hearing person. They did question and answer sessions with these patients.
What did the students respond to the most?
Practicing surgical skills received the highest rating, but the second highest rated was hearing patient stories: the empathy session. These are teenagers, and they were so empathic with the patients. They were so motivated by hearing these patient stories that it gives me chills. The fact that teenagers are capable of that level of empathy surprised me. I thought they would be focused on ambition and perhaps more on themselves. Instead, they’re thinking about helping people. I took that as a good sign.
Wilson Alobuia, MD, a general surgery resident, shows STEM-interested teens how to examine a liver using ultrasonography.
Why is it so important to get to students like these early?
There are reliable data in the primary care literature that suggest if minority patients have a doctor who looks like them, they are more likely to trust them and to adhere to recommendations. For example, they’re more likely to take antihypertensive medication, thereby lowering their blood pressure and ultimately reaping the benefit. That’s a lot of steps before you get to the outcome. The preliminary step is being able to relate to the doctor.
There is no information about whether race concordance between patients and surgeons has a positive influence on patients, partly because there are so few minority surgeons. We’re coming from the premise that if workforce diversity is good for patients treated in primary care settings, it is good for patients undergoing surgery.
I think the single most important thing for these teens is seeing other people who came from a similar place and hearing their stories in order to envision themselves succeeding in similar situations and know that this is possible. Some of the kids told us, “Well, when I heard their story, I knew I could do it too.” I think the human contact makes a huge difference in what they can imagine and plan.
So what’s next for your pipeline program?
To achieve financial stability as a program. We have funding for this upcoming summer, which will be our third time. We’re thinking about how to ensure that we can keep going, and we still need that ongoing financial stability. A second important goal is to continue to build our relationships with the kids who have already gone through the program and to support them as they move on in their academic careers, if they continue to want that.
Third, we look forward to sharing what we’ve learned with other, similar programs and learning from them. That’s something that we’ll be focused on in the upcoming year. I think that we could really all benefit from coming together to share knowledge about how to create and measure success in pipeline programs.
Ryan Syrek, MA, is section editor, Medscape Medical Students and Residents.